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journal homepage: www.elsevier.com/locate/ejor

Discrete Optimization

constraint programming

Tao Wang a,∗, Nadine Meskens b, David Duvivier c

a

University of Lyon, INSA-LYON, University of Jean Monnet Saint-Etienne, DISP - EA 4570, F-69621 Villeurbanne, France

b

Catholic University of Louvain, Louvain School of Management, B-7000 Mons, Belgium

c

University of Valenciennes and Hainaut-Cambresis, LAMIH - UMR CNRS 8201, Campus du Mont Houy, F-59313 Valenciennes, France

a r t i c l e i n f o a b s t r a c t

Article history: The daily scheduling of an operating theatre is a highly constrained problem. In addition to standard schedul-

Received 30 January 2014 ing constraints, many additional constraints on human and material resources encountered in real life should

Accepted 5 June 2015

be taken into account. These constraints concern the priority of operations, the aﬃnities between surgical

Available online 22 June 2015

team members, renewable and non-renewable resources, various sizes in the block scheduling strategy, and

Keywords: the surgical team’s preferences/availabilities. We developed two models in our research work, using mixed-

Combinatorial optimization integer and constraint programming respectively. These were compared using a real-life case in order to

Constraints satisfaction determine which one coped better with a highly constrained problem. A cross-comparison of the experi-

Linear programming mental results shows that the mixed-integer programming model provides a better performance using the

OR in health services weighted sum objective function than using the makespan minimization objective function. Conversely, the

Models comparison constraint programming model is better suited to the makespan minimization objective function than to the

weighted sum objective function. The originality of this research lies on three levels: (1) two models are pre-

sented in detail and compared using real data; (2) constraint programming is used to schedule the operating

theatre; (3) some new constraints are taken into account, such as the aﬃnities between team members in

the composition of surgical teams, and the priorities of patients such as diabetics.

© 2015 Elsevier B.V. and Association of European Operational Research Societies (EURO) within the

International Federation of Operational Research Societies (IFORS). All rights reserved.

a huge contribution to human activity and hence economic devel-

Health systems in many countries are in crisis. This situation is not opment. Health and its preservation are human needs that everyone

new; what is new, however, is the awareness that if the current trend wants to obtain and maintain.

continues most health systems will no longer be viable by 2015 (IBM, During the 1960s and 1970s, the prosperous economic situation in

2006). Belgium is no exception to this trend, even though it is some- Belgium allowed almost unlimited expenditure on health, which led

times said to have one of the best healthcare system in the world. Its to enough people being hired and enough material being bought to

strengths are its almost complete coverage of the population (Durant, ensure the supply of good quality services. However, from the 1980s

2006), the dynamics produced by the global supply system and the to the present day, major rationalizations have been undertaken

actual delivery of care, the quality of health education and healthcare focusing notably on hospitals.

providers, and the increasing professionalization of the healthcare The research reported in this paper focuses on one of the central

management structures (Itinera Institute, 2008). Nevertheless, Bel- and most expensive of hospital activities: the management of op-

gium is losing ground to other countries as regards the overall qual- erating theatres. The operating theatre in a hospital is composed of

ity of its healthcare system. The country was ranked sixth in the Euro operating rooms and one recovery room. This research aims to help

Health Consumer Index for 2013. First place went to the Netherlands, the operating theatre manager improve the organization of these fa-

followed by Switzerland, Iceland, Denmark and Norway (EHCI, 2013). cilities, in particular the assignment of surgical cases. The develop-

ment of an eﬃcient algorithm is required for assigning a set of sur-

gical cases to operating rooms during a period (often a week). This

∗

Corresponding author. Tel.: +33 477448954; fax: +33 477448921.

weekly operating theatre planning and scheduling problem is solved

E-mail addresses: tao.wang@univ-st-etienne.fr (T. Wang), in two phases. In other words, decisions are made at the tactical

Nadine.meskens@uclouvain-mons.be (N. Meskens), and then the operational level. First, a planning problem is solved to

David.Duvivier@univ-valenciennes.fr (D. Duvivier). obtain the date of surgery for each patient, allowing for the

http://dx.doi.org/10.1016/j.ejor.2015.06.008

0377-2217/© 2015 Elsevier B.V. and Association of European Operational Research Societies (EURO) within the International Federation of Operational Research Societies (IFORS).

All rights reserved.

402 T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413

availability of operating rooms and surgeons. Second, a daily schedul- research. This is an important constraint for team building that has

ing problem is solved to determine the sequence of operations in each not carried weight in previous research works (except in Meskens

operating room (Fei, Chu, & Meskens, 2009). et al., 2013). It has frequently been noted that the same people work

Managing the operating theatre is a complex task because surgi- together every day in the operating room for long periods of time.

cal cases must be planned and scheduled so as to minimize the costs A strong aﬃnity in teamwork can generate synergy through a co-

of operating rooms and satisfy the needs and requests of surgeons, ordinated effort, and allows each member to maximize his or her

anesthetists and nurses. Satisfying the patient’s needs and managing strengths and minimize his or her weaknesses. Obviously, the surgi-

the material resources must also be taken into account. Moreover, cal team’s effectiveness contributes to better communication and so

human and material resources are in limited supply, and legal regu- to quality and safety in the health care received by patients. A grow-

lations have to be fulﬁlled. ing number of studies have demonstrated this point (Carney, West,

Our study focuses on the daily scheduling of surgical cases at Neily, Mills, & Bagian, 2010; Kurmann et al., 2010; Sekhar and Manto-

the operational level, taking into account human and material con- vani, 2015; Tibbs & Moss, 2014; Weaver et al., 2010).

straints. The role of human beings in the decision-making process Each resource limitation included in an operating theatre man-

cannot be ignored. The operating theatre employs various teams of agement model leads to an increase in its complexity, in terms of the

workers (surgical, nursing, anesthetic, maintenance, etc.). Given the number of variables and/or the number of constraints and the com-

limitations on resources, scheduling their activities is crucial to the putational time required to solve the optimization problem. In the

eﬃcient performance of their work. Some constraints are linked to case of highly constrained problems, however, where the solutions

restrictions on the availability of resources: these include the open- space might be narrow and fragmentary, exact methods could pro-

ing hours of the operating rooms, the availability of surgeons, anes- vide optimal solution within reasonable time. Constraint program-

thetists and nurses, and the availability and numbers of surgical in- ming (CP) may also be another adequate tool for our highly con-

struments, and recovery beds. Other constraints are linked to the strained target problem. Indeed, the goal of CP is to solve problems

speciﬁcities of the resources (e.g. the versatility of the operating when combinatorial optimization has to handle many variables and

rooms, staff qualiﬁcations). Similarly, just as the operating rooms may constraints.

be dedicated to certain types of procedures, the medical staff may The major diﬃculty encountered in solving a combinatorial opti-

also be specialized. The operating theatre manager therefore has to mization problem is the explosion in the number of combinations as

try to harmonize resources and increase the versatility of the staff so the number of variables increases. The main problem when consid-

as to optimize the use of the operating theatre. ering such a huge set of combinations is the amount of computing

The daily scheduling of the operating rooms is a highly con- hours or days required to ﬁnd an optimal solution. This is not ac-

strained problem. A recent review by Meskens, Duvivier, and ceptable in the context of time-limited decision-making. However,

Hanset (2013) suggests that very few studies of this prob- unlike the classical mathematical approach, the constraint program-

lem have taken into account the constraints of both mate- ming paradigm is based on “reasoning” about the constraints and is

rial and human resources. The only constraints on human re- still eﬃcient when a lot of constraints are involved. This is one of the

sources which are normally considered are the number and reasons why we chose to use constraint programming. This method

availability of surgeons, stretcher-bearers and anesthetists and also has the advantage of providing the user with different modes of

sometimes of nurses and surgeon assistants (Beliën & Demeule- functioning when searching for a solution in the path tree of solutions

meester, 2007; Fei et al., 2009, 2010; Guinet & Chaabane, 2003; (Krzysztof, 2003).

Ghazalbash, Sepehri, Shadpour, & Atighehchian, 2012; Hashemi, Based on logic programming and graph theory, constraint pro-

Rousseau, & Pesant, 2014; Marcon, Kharraja, & Simonnet, 2003; gramming is an alternative to mathematical programming for com-

Roland, Di Martinelly, Riane, & Pochet, 2010; Vijayakumar, Parikh, plex problems that have a slow convergence. It is also an eﬃcient

Scott, Barnes, & Gallimore, 2013; Wang et al., 2014). Recent works approach to solving and optimizing problems in the event of nonlin-

(Marques, Captivo, & Vaz Pato, 2012; Van Huele & Vanhoucke, 2014) ear constraints, logical statements, or non-convex solution space. This

also consider the surgeon’s workload. A very small number of re- includes time-tabling problems, sequencing problems, and alloca-

search papers have taken into account priorities between patients tion or rostering problems (IBM ILOG, 2010). Constraint programming

(Cardoen, Demeulemeester, & Belien, 2009a, 2009b; Min & Yih, has been widely applied in industrial scheduling problems (Baptiste,

2010a, 2010b). In general, the material constraints taken into ac- LePape, & Nuijten, 2001; El Khayat, Langevin, & Riopel, 2006;

count are limited to the number of operating rooms, the availabil- Harjunkoski & Grossmann, 2002; Novas & Henning, 2014), but has

ity of speciﬁc materials and the number of beds in the recovery rarely been used in the ﬁeld of healthcare. Some perspectives in

room (Augusto, Xie, & Perdomo, 2010; Bulgarini, Di Lorenzo, Lori, the literature have recommended the use of constraint program-

Matarrese, Schoen, 2014; Fei, Meskens, & Chu, 2010; Ghazalbash et al., ming for solving nurse rostering problems in operating theatres

2012; Kharraja, Hammami, & Abbou, 2004; Pham, & Kinkert, 2008; (Trilling, 2006), staff scheduling in healthcare (Bourdais, Galinier, &

Santibanez, Begen, & Atkins, 2007; Testi & Tànfani, 2009; Vijayaku- Pesant, 2003), and medical resident scheduling problems (Topaloglu

mar et al., 2013; Van Huele & Vanhoucke, 2014). Stochastic aspects & Ozkarahan, 2011). Recently, Hashemi et al. (2014) as well as Van

have been integrated by some authors in the planning and schedul- Huele and Vanhoucke (2014) used constraint programming based

ing problem of operating theatre such as Denton, Viapiano, and on a column generation approach to resolve a surgery-planning and

Vogl (2007), Hans, Wullink, Van Houdenhoven, and Kazemier (2008), scheduling problem. Zhao and Li (2014) resolved a scheduling of

Min and Yih, 2010a, 2010b), Lamiri (2008), Lamiri, Xie, Dolgui, and elective surgeries problem in an ambulatory surgical center. They

Grimaud (2009). proposed and compared constraint programming and Mixed Integer

However, in real life other constraints are also very important and Nonlinear Programming models to solve the scheduling problem. But

we propose in this research to take them into account. These include the treated problem was not highly constrained. The authors did not

human constraints such as the priority of some surgical cases (for ex- take into account any human or material constraints.

ample, children and people suffering from diabetes should be sched- In order to demonstrate the advantages of applying CP to a highly

uled at the beginning of the day), the preferences of surgeons, nurses constrained problem as against a traditional method, we compare a

and anesthetists, and material constraints such as the versatility of constraint programming model (CP-MOD) to a traditional mathemat-

operating rooms and the availability of medical supplies. ical programming one (MP-MOD).

In particular, the aﬃnity relationship between two persons who In our two models, new constraints have been taken into ac-

work on the same surgical cases has been taken into account in this count, such as the priority of operations, the aﬃnities between

T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413 403

surgical team members, renewable and non-renewable resources, operation-recovery process is a two-stage no-wait ﬂow-shop, so the

various sizes in the block scheduling strategy, and the surgical team’s scheduling of operating theatres should ensure that there will be at

preferences/availabilities. The comparison between the two models least one available recovery bed at the end of each operation. When

is the main contribution. no bed is (or will be) free at the end of the surgery, the operation is

Following this introduction, the problem is deﬁned mathemati- not (or will not be) performed. The patient can be transferred to the

cally in the second part of the paper, which sets out its notations and normal bed only after his/her recovery.

hypothesis. The third and fourth parts describe respectively the MP

and CP scheduling models, and the ﬁfth part compares the two mod- 2.1. Problem statement

els. This comparison is made on the one hand by the minimization

of the makespan, and on the other hand by the minimization of the The notations of input data used for the two models are listed

weighted sum of the completion time. Finally we present our conclu- below:

sions and perspectives. The set of all the surgical cases

o An operation: o∈

T The set of time slots in a day

In this research, we ﬁrst need to describe mathematically the t A time slot: t∈T

problem of daily scheduling of surgical cases. The time horizon is set The set of operating rooms

to one day and divided into T time slots (t ∈{1..T}). In our implementa- R The number of operating rooms: R=| |

tion each time slot is ﬁxed to 30 minutes, the most common divisor of r An operating room: r∈

S The set of surgeons

the surgery durations that we collected from a ﬁeld study. This tem-

s A surgeon: s∈S

poral granularity is quite close to reality, but does not substantially A The set of anesthetists

increase the size of the search space. There is a set of R operating a An anesthetist: a∈A

rooms. Each room will then be available for T time slots, which will N The set of nurses

correspond to free periods for the surgeons. n A nurse: n∈N

s The set of operating rooms allocated to surgeon s

In practice, there are two types of operations: elective operations, Ωs The set of operations allocated to surgeon s

which are planned by the surgeon in consultation with the patient; Ωb The set of operations with high priority that start earlier than

and emergency operations, which — as their name suggests — are the others

unplanned and arrive unexpectedly. In general, operations for emer- Ωm The set of operations with medium priorities

Ωe The set of operations with low priority that start later than the

gency patients are performed in dedicated operating rooms; some of

others

them are allowed to be scheduled together with elective operations, Os The number of operations allocated to surgeon s: Os = | Ωs |

if patients’ clinical conditions are relatively stable. In our model, each Ob The number of operations taking place at the beginning of the

operation included in the set of operations to be assigned is denoted day (high priority): Ob = | Ωb |

by o∈. Om The number of operation with medium priorities : Om = | Ωm |

Oe The number of operations that take place at the end of the day

A set of material and human resources is also required for each (low priority): Oe = | Ωe |

operation. Concerning human resources, the legislation requires the do The duration of operation o (in number of time slots)

presence of at least one surgeon, one anesthetist, and two nurses for ESo The earliest start of operation o (time slots)

each surgical case. The aﬃnity relationships between members of LSo The latest start of operation o (time slots)

Kρ The set of renewable resources

surgical team are taken into account. Some specialized works (Leach,

Kυ The set of non-renewable resources

Myrtle, & Weaver, 2011; Mazzocco et al., 2009; Weaver et al., 2010) k A resource: k∈{ Kρ ∪ Kυ }

showed that aﬃnities in a surgical team had an impact on the perfor- ρ

mok The quantity of the renewable resource k required by operation

mance of the team in terms of communication, cooperation, and co- o

ordination, which itself has a signiﬁcant impact on the quality of care mvok The quantity of the non-renewable resource k required by

operation o

delivered to the patient. Their estimations are obtained by means of ρ

Mk (t ) The quantity of the renewable resource k, available at moment t

a ﬁeld survey and interviews with the surgical staff. Since aﬃnity re- Mkv The quantity of the non-renewable resource k, available for the

lationships are not all evaluated equal between members, the lower day

value is thought to be acceptable to qualify a bilateral aﬃnity rela- MS (s, t) The availability of surgeon s at time t: MS (s, t) ∈ {0, 1}

MN (n, t) The availability of nurse n at time t: MN (n, t) ∈ {0, 1}

tionship. Hence an overall evaluation of these bilateral aﬃnity rela-

MA (a, t) The availability of anesthetist a at time t: MA (a, t) ∈ {0, 1}

tionships will contribute to building eﬃcient surgical teams. B The set of recovery beds

We make a distinction between renewable and non-renewable re- b A recovery bed: b∈B

sources. Material resources can be renewable (Kρ ) or non-renewable dbo The duration of the recovery after operation o (in number of

(Kυ ). For example, sterile medical trays, which are a basic require- time slots)

B1,o Beginning of operation o, in an operating room (time slots)

ment for operations, need to be completely sterilized between uses, B2,o Beginning of recovery, in the recovery room, at the end of

and so are non-renewable resources in the course of a day. Human operation o (time slots)

resources are typically renewable resources (Kρ ). C2,o End of recovery of the operation o, in the recovery room(time

We consider the existence of three kinds of priority for opera- slots)

Cmax Makespan, end of recovery, in the recovery room, at the end of

tions: High, Medium and Low. Operations with a high priority (set

the latest operation o (time slots)

Ωb ) start earlier than the other operations; they cover children, di- AffSN(s,n) The aﬃnity relationship between surgeon s and nurse n (∈{0,1})

abetics, ambulatory operations, etc. Operations with a low priority AffSA(s,a) The aﬃnity relationship between surgeon s and anesthetist a

(set Ωe ) are carried out later than the others, and are mainly infec- (∈{0,1})

tious cases that contaminate the room and require more cleaning af- AffNA(n,a) The aﬃnity relationship between nurse n and anesthetist a

(∈{0,1})

ter the operation. We have also added preferential constraints related AffNN(n1 ,n2 ) The aﬃnity relationship between two nurses n1 and n2 (∈{0,1})

to the preferences of the surgeons for particular operating rooms and

to the availability of human resources. As discussed above, three sets of operations were created: Ωb , con-

The limited capacity of recovery beds is taken into account. In taining all the operations that have to be carried out before the other

practice, the ratio of operating rooms to recovery beds is 1–1.5 operations; Ωe , containing those that have to be carried out after

(legal constraint), or 1–2 if precautionary measures are taken. The the other operations; and Ωm , containing those that have no special

404 T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413

Table 1

Example of matrix MS (s, t), giving the availability of Surgeons 1, 2 and 3 between 8.00 and 20.00.

8.00 8.30 9.00 9.30 10.00 10.30 11.00 11.30 12.00 … 19.30

T 1 2 3 4 5 6 7 8 9 … 24

Surgeon 1 0 0 0 0 0 1 1 1 1 … 1

Surgeon 2 1 1 1 1 1 0 0 0 0 … 0

Surgeon 3 0 0 0 1 1 1 1 1 0 … 0

Example of aﬃnity matrix Aff(p1 ,p2 ).

(ki × Aff(p1 , p2 )) between the members in the same team. How-

Anes.1 Anes.2 … Anes.A Nurs.1 Nurs.2 … Nurs.N ever, this leads to the problem of choosing these weights ki . In order

to ensure a minimum aﬃnity between all pairs of the members in

Surg.1 9 8 … 0 9 7 … 8

Surg.2 7 7 … 6 7 7 … 7

each team, we have chosen to transform the aﬃnities into binary val-

… … … … … … … … … ues using a threshold. Thus, the integer values are of no use as the

Surg.S 5 6 … 8 0 9 … 9 input data of our mathematical models since the aﬃnity matrix is

Nurs.1 8 8 … 8 5 … 8

only used to answer a binary choice: whether two persons will work

Nurs.2 3 8 … 9 8 … 7 together in a same surgical team. Directly using integer values can-

… … … … … … … … not enrich the results of the models, but increases the computational

Nurs.N 9 8 … 9 8 3 … burden. If the aﬃnity score is greater than or equal to the threshold,

then the two persons p1 and p2 will be happy to work together. Oth-

erwise, the two persons will refuse to work in a same team. Obviously

a high threshold may hinder team-building due to incompatibility

requirement. In addition, we can deﬁne the earliest/latest start times

between members. Therefore, if, for example, the threshold is set to

(ESo and LSo ) for each operation when needed.

5, the aﬃnity matrix described above can be transformed as follows

Operations are deﬁned by a set of characteristics. We assume that

(Table 3). The variables AffSA(s,a), AffSN(s,n), AffNA(n,a), AffNN(n1 ,n2 )

the duration of a particular operation, do , can be predicted in advance.

obtain their values from the transformed matrix. However, the value

Furthermore, for the comfort and safety of the patient, we assume

of this threshold has to be deﬁned. Several approaches are possible.

that the operation starts as soon as possible (ESo ) and no later than

One of them consists in starting from a value that is equal to the aver-

(LSo ) (expressed in time slots).

age value of the team members’ aﬃnities, and transforming the ma-

Renewable resources are available again once the operation ter-

trix into a binary matrix. If there is no solution due to a lack of surgical

minates. For each operation, we know the quantity of renewable re-

ρ teams, then we should try again with a lower threshold value (us-

source required by operation mok , and it will be compared to the

ρ ing, for instance, a dichotomy approach to compute the new value).

amount of available resource Mk (t ) at time t. Unlike renewable re- If there is a solution and there is enough time to restart a resolution,

sources, consumed non-renewable resources cannot be reused by then we can increase the threshold value and try to solve the prob-

other following operations. Only the total use of each resource mvok lem with this value, and so on. The resulting approach is a tradeoff

is compared to the available quantity of the non-renewable resource between a set of pretreatments and mathematical models. All ba-

Mkv for the day. sic tests are implemented in the pretreatment phase to simplify the

The availability of each surgeon is expressed in a matrix, MS (s, t). mathematical modelling.

Table 1 gives an example of such a matrix, and shows that Surgeon

1 is available for operations from 10.30, Surgeon 2 between 8.00 and

10.30 and Surgeon 3 between 9.30 and 12.00. In the same way as for 2.2. Assumptions

the surgeon, two availability matrices are given to describe respec-

tively the availabilities of the anesthetist MA (a, t), and of the nurse A list of assumptions must be enumerated in order to complete

MN (n, t). the description of our framework:

The aﬃnity relationship for teamwork is expressed through an

aﬃnity matrix Aff(p1 ,p2 ), where each row and each column repre- • No surgeon can operate on more than one patient at the same

sents a person (a surgeon, an anesthetist, or a nurse). For each pair time. Similarly, no recovery bed can be occupied by more than

of persons, a score of 0–9 is assigned based on the preferences ex- one patient at the same time.

pressed by them (the lower of two unilateral notes). Mutual incom- • All the scheduled patients are ready for their surgery on the given

patibility is denoted by 0 and strong preference is denoted by 9. day.

Several pretreatments are directly applied to this matrix before its • All scheduled operations have to be performed during the current

use in the mathematical model through a Graphical User Interface. day, i.e. no operation can be postponed.

The full description of all these treatments lies outside of the scope • The induction time for each operation, and the post-operation

of this paper. However, we may mention that their objective is to en- clean-up after the operation, are included in the operating time.

sure the homogeneity of the values to a certain extent, and to ensure • The recovery beds in the recovery rooms are identical; that is, the

that there are suﬃcient non-null values to avoid any lack of teamwork patient can be transferred to any available recovery bed.

with suﬃcient aﬃnities. • Once a surgical case has started in an operating room, it cannot be

It might be possible to use the integer values in Table 2 directly interrupted, i.e. there is no pre-emption.

in the mathematical models. Then we need to ensure with appropri- • The time needed at the start of every work day to clean the op-

ate constraints, that a team can be built if the average aﬃnity value erating rooms before all operations is not taken into account. The

between the members is greater than a predeﬁned threshold, which post-operation clean-up time (cleaning time after each operation)

could be the median value5 between 0 and 9 for example. However, is included in the operating time. These ‘setup’ times are indepen-

the average value may “hide” some dissatisfaction between members dent of the operating schedule. However, operations may be se-

in the same team. In another solution, ensuring that the aﬃnity crite- quenced in a particular order, as mentioned above. For example,

T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413 405

Nurs.N

…

Nurs.2

AffNN(n1 ,n2 )

AffSN(s,n)

Nurs.1

3. The MP model

Anes.A

mathematically formulated by a mixed integer programming (MP)

model. The objective is to minimize the makespan of the generated

…

work schedule.

The operations have to be placed individually; each one is de-

Anes.2

over the operating duration. Within a room r, the duration of each op-

AffNA(n,a)

AffSA(s,a)

Anes. 1

ing the assignment of operation o in this room. Only the binary vari-

ables relative to the operation for the room in question and for the

sequence of time slots occupied by the operation will be set to 1;

Nurs.N

Nurs.2

Nurs.1

Surg.2

Surg.S

Surg.1

…

motivated by the fact that one of our objectives is to obtain the de-

tailed schedule of each resource. As illustrated in Fig. 1, binary vari-

Example of aﬃnity matrices AffSA(s,a), AffSN(s,n), AffNA(n,a) and AffNN(n1 ,n2 ) after threshold applied.

ables take the value 1 not only at the beginning of the operation but

throughout its duration in a given room r.

Nurs.N

…

…

1

1

1

1

OTR(o,t,r) = 1 if operation o is assigned at time t to operating room r

…

…

…

…

…

…

…

…

0 otherwise

OTB(o,t,b) = 1 if operation o is assigned at time t to recovery bed b

Nurs.2

0 otherwise

…

…

1

1

0 otherwise

NTR(n,t,r) = 1 if nurse n is assigned at time t to operating room r

Nurs.1

0 otherwise

…

…

1

1

1

0

0 otherwise

Anes.A

…

…

1

1

1

0

1

…

…

…

…

…

…

…

…

…

s.t.

C2,o = B2,o +dbo − 1 (1b)

Anes.2

…

1

1

1

1

Anes.1

o −1

R LSo +d

do .(do −1)

t.OT R(o, t, r) −

…

…

1

1

1

0

2

r=1 t=ESo

B1,o = ∀o ∈ (2)

do

Nurs.N

Nurs.2

Nurs.1

Surg.2

Surg.S

Surg.1

Table 3

…

B LSo +d

o +dbo −1

dbo .(dbo −1)

t.OT B(o, t, b) − 2

b=1 t=ESo +do

B2,o = ∀o ∈

dbo

(3)

406 T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413

O

N

OT R(o, t, r) ≤ 1, ∀r ∈ , ∀t ∈ T (4) 2 × ST R(s, t, r) = NT R(n, t, r), ∀s ∈ S, ∀t ∈ T, ∀r ∈ s (19)

o=1 n=1

O

R

r∈s o=1 r=1

+do −1

A

R LSo

ST R(s, t, r) = AT R(a, t, r), ∀s ∈ S, ∀t ∈ T, ∀r ∈ s (21)

OT R(o, t, r) = do, ∀o ∈ (6)

a=1

r=1 t=ESo

⎢ t+do−1 ⎥

⎢ OT R(o, τ , r ) ⎥

R T −d

o +1 ⎢ ⎥ ∀s ∈ S, ∀n ∈ N, ∀t ∈ T, ∀r ∈ (22)

⎢ τ =t ⎥ = 1, ∀o ∈ (7)

⎣ do ⎦

r=1 t=1

O ∀s ∈ S, ∀a ∈ A, ∀t ∈ T, ∀r ∈ (23)

OT B(o, t, b) ≤ 1, ∀b ∈ B, ∀t ∈ T (8)

o=1

NT R(n, t, r) + AT R(a, t, r) − 1 ≤ A f f NA(n, a)

B LSo +d

o +dbo −1

∀n ∈ N, ∀a ∈ A, ∀t ∈ T, ∀r ∈ (24)

OT B(o, t, b) = dbo, ∀o ∈ (9)

b=1 t=ESo +do

⎢ t+db

o −1 ⎥

⎢ OT B (o, τ , b) ⎥ ∀n1 , n2 ∈ N, n1 = n2 , ∀t ∈ T, ∀r ∈

o +1 ⎢ τ =t

B T −db

⎥ (25)

⎢ ⎥ = 1, ∀o ∈ (10)

⎣ dbo ⎦

OT R(o, t, r) = 0, ∀o ∈ , ∀r ∈ , ∀t ∈/ [ESo, LSo + do]

b=1 t=1

(26)

⎛ LSo2 +do2 −1

⎞

OT B(o, t, b) = 0, ∀o ∈ , ∀b ∈ B, ∀t ∈/ [ESo + do, LSo + do + dbo]

⎜ OT R(o2 , t, r) ⎟

⎜ t=ESo2 ⎟ (28)

B1,o1 ≤ B1,o2 + ⎜1 − ⎟T,

⎝ do2 ⎠ The objective function (1a) and constraints (1b) and (1c) ensure

minimization of the makespan of the operating theatre.

The beginning time of an operation or a recovery is given by con-

∀o1 ∈ b , ∀o2 ∈ m , ∀r ∈ (12)

straints (2) and (3). They allow us to locate the ﬁrst value 1 of the

variables OTR declared for the operation o in an operating room r or

⎛ LSo3 +do3 −1

⎞ on a recovery bed b. Constraints (4) indicate that two operations can-

not take place at the same time in the same operating room. Further-

⎜ OT R(o3 , t, r) ⎟

⎜ t=ESo3 ⎟ more, there certainly exists an exact match between every operation

B1,o2 ≤ B1,o3 + ⎜1 − ⎟T, and its surgeon. Thus, the operations allocated to each surgeon, se-

⎝ do3 ⎠

lected from the set of surgeons S, are known in advance. Constraints

(5) prevent any surgeon from conducting two operations at the same

∀o2 ∈ m , ∀o3 ∈ e , ∀r ∈ (13) time in different operating rooms. Constraints (6) and (7) were intro-

duced into the model to express the fact that an operation o has to

take place over do consecutive time slots. Constraints (6) require the

R

O

ρ ρ number of variables set to 1 to be equal to do , while constraints (7)

mok OT R(o, t, r) ≤ Mk (t ), ∀t ∈ T, ∀k ∈ K ρ (14)

specify that the variables set to 1 in this interval must be continuous,

r=1 o=1

due to the fact that the integer division of the sum of consecutive 1

by do must be equal to 1. In this way, we ensure that there is only one

R

O

mυok

T

OT R(o, t, r) ≤ Mkυ , ∀k ∈ K υ (15) string of consecutive 1, representing the operation (zero everywhere

do else). Constraints (8), (9) and (10) express the conditions at the recov-

r=1 o=1 t=1

ery room stage, for instance the fact that there is only one patient at a

OT R(o, t, r) ≤ MS (s, t ), ∀s ∈ S, ∀t ∈ T, ∀r ∈ s (16) time in a recovery bed, and that the variables OTB set to 1 have to be

o∈s continuous throughout the interval of time dbo . Constraints (11) en-

sure continuity between two stages of the procedure; the expression

ST R(s, t, r) = OT R(o, t, r), ∀s ∈ S, ∀t ∈ T, ∀r ∈ s (17) on the left indicates the last OTR set to 1 at the operating stage of an

o∈s operation, while that on the right represents the ﬁrst OTB set to 1 at

the recovery stage of the same operation.

R Constraints (12) and (13) are precedence constraints. Similarly,

NT R(n, t, r) ≤ MN (n, t ), ∀n ∈ N, ∀t ∈ T (18) they express the timing requirements for the operations included

r=1 in the sets Ωb and Ωe . High priority operations should start before

T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413 407

those with medium priorities, but low priority operations after those Earliest start time latest end time

with medium priorities. Constraints (14) and (15) represent the lim-

its on the renewable and non-renewable resources. The difference Operation

lies in the fact that we have to weight these variables by the inverse

of the duration of the operation to obtain comparable values. Con-

straints (16) and (17) express the availability of surgeon s at time t by Start time End time t

MS (s, t). Similarly, constraints (18) and (20) are derived from con-

Fig. 2. An interval variable.

straints (16) and express the availability of nurse and anesthetist at

time t by MN (n, t) and MA (a, t). Constraints (19) and (21) express

the fact that a team consists of a surgeon, an anesthetist and two solve time-tabling and sequencing problems usually characterized by

nurses. Constraints from (22) to (25) describe the implementation of non-linear constraints, logical constraints, and incompatibility con-

aﬃnity relationship in the model. Team members can work together straints. The CP engine is often used as a fast generator of feasible so-

only when all combinations Aff(p1 ,p2 ) are greater than or equal to lutions, but takes a considerable amount of time in terms of ﬁnding

the aﬃnity threshold. Constraints (26) and (27) express that one op- optimal solutions. Detailed analysis will be described in the Section 5.

eration performed by surgeon s should be placed in the time win-

dow between its earliest start time and latest end time, only in one 4. The CP model

of the operating rooms allocated to surgeon s. They also ensure that

there is no operation planned when the surgeon cannot operate. Fi- Constraint programming deals not only with logical constraints

nally, constraints (28) ensure that post-operative recovery can only used in constraint satisfaction problems (CSP), but also with mathe-

be placed in the time window between its earliest start time and lat- matical constraints that are usually solved by classical approaches. A

est end time. CP model is deﬁned in three parts. The ﬁrst part describes all decision

Constraints (7) and (10) should be linearized to be used with Cplex variables; the second gives the domain for each of these variables, in-

solver. One of the solutions is to replace each of the two constraints cluding discrete values; the third contains various sets of constraints,

with three linear constraints and new decision variables. The equiva- representing logical and mathematical relationships between

lent constraints to (7) are designed as following. variables.

x(o, t, r) ≥ OT R(o, t, r) − OT R(o, t − 1, r) ∀o ∈ , ∀t ∈ T (7a)

4.1. Decision variables

T

R

x(o, t, r) = 1 ∀o ∈ (7b) The operations are represented by interval variables instead of bi-

t=1 r=1 nary variables in MP-MOD. An interval variable represents an interval

of time during which an operation is performed. In general, it is de-

OT R(o, 0, r) = 0 ∀o ∈ , ∀r ∈ (7c) ﬁned (see Fig. 2) by its inherent attributes, such as earliest start time,

latest end time and duration, but its position in time or its start time

In the same way, the equivalent constraints to (10) are designed are unknowns in CP-MOD. In contrast, an operation’s start time in

as following. MP-MOD should be deduced from output results, once the optimal

solution is found. The deﬁnition of interval variables for operations is

1 if recovery after operation o starts at time t in

y(o, t, b) = bed b given as follows (deﬁnition 29).

0 otherwise

INTERVAL operation (o in ) in ESo .. LSo + do − 1 SIZE do

y(o, t, b) ≥ OT B(o, t, b) − OT B(o, t − 1, b) ∀o ∈ , ∀t ∈ T (10a) (29)

T

B 4.2. Logical relationships

y(o, t, b) = 1 ∀o ∈ (10b)

t=1 b=1 An operation can be performed only when all human and mate-

rial resources are brought together. A six-tuple <o,s,r,n1 ,n2 ,a> is pro-

OT B(o, 0, b) = 0 ∀o ∈ , ∀b ∈ B (10c) posed to represent team building for a given operation. The objective

is to make a preselecting constraint that generates all possible sur-

An overview analysis of MP model is performed to estimate the

gical teams which satisfy aﬃnity constraints. An instance of the six-

size of the scheduling problem. The number of decision variables de-

tuple is composed of an operation o, the surgeon s who is capable

pends on (o+s+n+a)∗t∗r+o∗t∗b, and the number of constraints are

to perform the operation o, an operating room r allocated to s, two

given in Table 4 below. The size of the problem scales up quickly with

nurses n1 , n2 , and an anesthetist a, with all (Aff(p1 ,p2 ) > threshold)

the time-splitting scheme and the number of operations, surgeons,

satisﬁed. The set of all possible surgical teams can be expressed in

nurses, anesthetists, operating rooms, and recovery beds. A MP opti-

terms of the deﬁnition (30). In the same way, the set of all operation-

mization engine will take a considerable amount of time to analyze

recovery combinations is obtained by the deﬁnition (31). These two

the model’s feasibility and to calculate the optimal solution in a frag-

deﬁnitions also considerably reduce the search space of the schedul-

mented solution space.

ing problem.

∀s ∈ S, ∀o ∈ s , ∀r ∈ s , ∀n1 , n2 ∈ N, n1 = n2 , ∀a ∈ A,

Teams = < o, s, r, n1 , n2 , a > A f f SA(s, a) × A f f SN(s, n1 ) × A f f NA(n1 , a) × A f f SN(s, n2 ) (30)

×A f f NA(n2 , a) × A f f NN(n1 , n2 ) > 0

Due to the limits introduced by the use of linearization in solv- Recovery = {< o, b > |∀b ∈ B, ∀o ∈ } (31)

ing scheduling problems, the effectiveness of MP models is appar-

ently not guaranteed, especially for large-scale problems. In con- In one of the solutions generated by the CP-MOD, only one six-

trast, constraint programming offers suitable modeling techniques to tuple per operation will be present. The others, having not satisﬁed

408 T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413

Table 4

Overview analysis about number of constraints in MP-MOD.

Set of constraints Decision matrix Number of constraints Set of constraints Decision matrix Number of constraints

S

4 OTR R∗T 17 STR, OTR T ∗ |s |

s=1

5 OTR S∗T 18 NTR N∗T

6 OTR O 19 STR, NTR S∗T∗R

7 OTR O 20 ATR A∗T

8 OTB B∗T 21 STR, ATR S∗T∗R

9 OTB O 22 STR, NTR S∗T∗R∗N

10 OTB O 23 STR, ATR S∗T∗R∗A

11 OTR, OTB O 24 NTR, ATR N∗T∗R∗A

12 OTR R∗Ob ∗Om 25 NTR N²∗T∗R

13 OTR R∗Om ∗Oe 26 OTR O∗T∗R

S

14 OTR T∗|Kρ | 27 OTR Os ∗ T ∗ (R − |s |)

s=1

15 OTR |Kυ | 28 OTB O∗T∗B

S

16 OTR T ∗ |s |

s=1

all constraints and the objective function, are absent. This can be ex-

pressed by a Boolean function (32).

2

true, ∀x ∈ Teams, x is present

presenceOf(x) = (32)

false, ∀x ∈ Teams, x is absent 1

operating room or a recovery bed, can be used at moment t by only

one operation or one patient, so there is no question of overlap be- Fig. 3. Example of stepwise function stepwise{0→1, 1→2, 0→3, 2→4, 1→5}.

tween two operations in the schedule of a resource above. However

an overlap is allowed when two operations use different resources.

Here, all individual schedules of these resources are deﬁned as fol-

h h

lows, but no-overlap constraints will be added in the model’s section

StepAtStart(o,h) StepAtEnd(o,h)

below. Deﬁnitions from (33) to (37) give different schedules for sur-

geon s, nurse n1 , n2 , anesthetist a, operating room r, and recovery bed

b as soon as a feasible solution found. Operation o Operation o

Sched(s) = operation(x)∀x ∈ Teams, presenceOf(x), x.s = s

Fig. 4. Example of stepAtStart(o,h) and stepAtEnd(o,h).

∀s ∈ S (33)

Sched (n) = operation (x)∀x ∈ Teams, presenceOf (x),

Avail(n ∈ N) = stepwise(t ∈ T ) Mn (n, t ) → t; 0 (39)

x.n1 = n or x.n2 = n} ∀n1 , n2 ∈ N (34)

Sched(a) = operation(x)∀x ∈ Teams, presenceOf(x), x.a = a Avail(a ∈ A) = stepwise(t ∈ T ) Ma (a, t ) → t; 0 (40)

scribed by a simple stepwise function. The quantity of a renewable

resource is reduced at the beginning of an operation and restored at

Sched(r) = operation(x)∀x ∈ Teams, presenceOf(x), x.r = r

the end of it. Two additional functions are introduced to model the

∀r ∈ (36) consumption and the production of a cumulative resource. The value

of function stepAtStart(o,h) changes to h at the start of an interval

variable, an operation o in our case, while the value of stepAtEnd(o,h)

Sched(b) = operation(y)∀y ∈ Recovery, presenceOf(y), y.b= b changes at the end of the operation o. Therefore, a function Qty(k) is

∀b ∈ B (37) given in (41) to express the available quantity of renewable resource

k over time (Fig. 4).

The availabilities of each member in a surgical team are expressed

ρ

by a stepwise function. A typical stepwise function, denoted by step- Qty(k ∈ K ρ ) = stepwise(t ∈ T ) Mk (t ) → t; 0

wise(i in 1..n) {Value[i] → Time point[i]} is often used to model the ρ

ρ

availability or the use of a resource over time. An example of a step- − stepAtStart(o, mok )+ stepAtEnd(o, mok ) (41)

wise function is illustrated in Fig. 3. Using its concept, the functions o∈ o∈

nurse and anesthetist in time. 4.3. The constraint programming model

Avail(s ∈ S) = stepwise(t ∈ T ) Ms (s, t ) → t; 0

The CP-Model of the daily scheduling problem is introduced be-

Ms (s, 1), t < 1 low.

= Ms (s, i + 1), ∀i ∈ [1..n − 1], ∀t ∈ [ti , ti+1 ) (38)

0, t > tn MinimizeMax(endOf(o)) ∀o ∈ (42)

T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413 409

been developed for the purpose of obtaining linear constraints. In

¬(start(δ1 ) < start(δ2 ) < end(δ1 )) ⇔ noOverlap(Sched(β))

the case of linear programming, where the solver accepts only linear

∀δ1 , δ2 ∈ Sched(β), ∀β ∈ S ∪ N ∪ A ∪ ∪ B (43) constraint and linear objective function, linearization becomes a ma-

jor obstacle to the modelling work at a conceptual level. There is no

presenceOf(∀x1 ∈ Teams, x1 .o = o) ⇒ ¬(∃x2 ∈ Teams, guarantee that equivalent and eﬃcient linear constraints can always

(44)

x2 .o = o, x2 = x1 , presenceOf(x2 )) ∀o ∈ be found. None of these issues matter in the CP model.

Second, the constraint section of the CP model takes into account

only some precedence and overlap constraints; all the others, like

presenceOf(∀y1 ∈ Recovery, y1 .o = o) ⇒ ¬(∃y2 ∈ Recovery, aﬃnity constraints from (22) to (25) in the MP model, can be directly

y2 .o = o, y2 = y1 , presenceOf(y2 )) ∀o ∈ (45) integrated into the deﬁnitions of team tuples (30). This can signiﬁ-

cantly reduce the search space of the daily scheduling problem. In

addition, the start time of each operation, deﬁned by (2), becomes

End(operation(x)) + 1 = Start(recovery(y)) an inherent unknown of the interval variables; the availability con-

∀x ∈ Teams, ∀y ∈ Recovery, x.o = y.o (46) straints (16) (18) and (20) can be replaced by (38), (39) and (40) in

the CP model. Constraint programming using logical operators, vari-

ables, and expressions is much more intuitive for the modelling work

End(operation(x1 )) ≥ Start(operation(x2 )) of scheduling problems, compared with mathematical programming.

∀x1 , x2 ∈ Teams, x1 .r = x2 .r,

(x1 .o ∈ b , x2 .o ∈ m ) or (x1 .o ∈ m , x2 .o ∈ e ) 5. Experimental results

(47)

Once the two models have been properly formulated and speci-

ﬁed, we are now able to compare them and assess which is the more

successful. The models were both run on a Core2TM Duo processor

presenceOf(x) ⇒ Avail (s) ∧ Avail (n1 ) ∧ Avail (n2 ) ∧ Avail (a) = 1 (2 GHz, 4 GB RAM, Operating System: Windows 7). The MP-MOD,

∀x ∈ Teams, x.s = s, x.n1 = n1 , x.n2 = n2 , x.a = a, using mixed-integer programming, was coded in Optimization Pro-

start(operation(x)) ≤ t ≤ end(operation(x)) gramming Language and solved by Cplex 12.5 (IBM ILOG, 2010).

(48) The CP-MOD uses a constraint-programming method. It was

solved by the Constraint Programming Optimizer included in IBM

ILOG optimizers. This method possesses the descriptive power

Qty(k) ≥ 0 ∀k ∈ K ρ ∪ K υ (49)

needed to model this kind of problem accurately. Built on an event-

The objective function (42) ensures minimization of the makespan based propagation mechanism with back-tracking structure, con-

of the operating theatre. The function endOf(o) gives the end of re- straint programming also offers the advantage of ﬁnding a feasible

covery of the operation o, and we have endOf(o) = C2, o . Constraints solution via a depth-ﬁrst search algorithm, or a more sophisticated,

(43) are used to indicate that no overlap is allowed between two branch-and-bound type of search can be carried out to ﬁnd an opti-

operations inside an individual schedule of any resource, such as mal solution. However such searches tend to involve extremely long

surgeon, nurse, anesthetist, operating room, and recovery bed. Con- computing time (Fages, 1996).

straints (44) and (45) state that for a given operation, the presence

of one surgical team and one recovery bed is exclusive in a gen- 5.1. Input data

erated solution, hence there does not exist another alternative that

is admitted at the same time. Constraints (46) and (47) are prece- In order to evaluate the proposed methods of improving the prac-

dence constraints. Constraints (46) ensure that recovery starts as tical arrangement of surgical cases in the operating theatre, real life

soon as the operation ﬁnishes. Constraints (47) express that opera- data from a Belgian University Hospital are used in this study. In this

tions with higher priority should start before those with lower prior- hospital, there are nine surgical specialties: stomatology, gynecology,

ity. Constraints (48) are used to ensure that a six-tuple can be cho- urology, orthopedic surgery, ENT/otorhinolaryngology, ophthalmol-

sen into a feasible solution only if all necessary human resources are ogy, pediatric surgery, plastic surgery and abdominal surgery. The op-

available during the whole period of operation. Finally, Constraints erating theatre in this hospital is composed of 4 operating rooms and

(49) concern the available quantity of renewable and non-renewable one recovery room with 8 beds. Normally, all the operating rooms

resources. are open from 8 a.m. to 6 p.m., and can be extended to 8 p.m. if nec-

essary. The recovery room opens simultaneously with the operating

4.4. Comparison with the MP model rooms and does not close until the last patient has left the operating

theatre.

There are various ways to model this daily scheduling problem, The main aim is to provide the operating theatre manager with

and the choice of modeling is crucial to the performance of the model. a good solution, which satisﬁes all the constraints and can be com-

Our MP and CP models have been optimized but remain accurate to puted in a short time. The data used in this study come from 6321

the real world constraints. The comparison between these two mod- records from the operating theatre, collected over a one-year period.

els is based on our choice of modeling that aims at testing their re- The data consist mainly of date of surgery, induction time, the start

spective abilities. time and end time of surgery, the time the patient left the operating

First, the decision variables are deﬁned in different ways. Binary room, the surgeon and specialty for each surgical case, the reason for

variables are used in the MP model to describe each of the ﬁve de- admittance and some personal information (the patient’s birthday,

cision variables in a three-dimensional matrix. The core element of gender, etc.). Overtime hours are not considered because we have de-

this daily scheduling problem, the operations, is represented by a se- ﬁned the time slots for a working day as ﬁxed. However they could be

quence of OTR (o,t,r). However in the CP model, an integrated interval taken into account by allocating them a speciﬁc hourly cost, higher

variable is suﬃcient to describe an operation. than that which applies during the normal day.

In order to ensure that an operation is correctly represented in The same surgical cases undertaken by the same surgeons using

output results, Constraints (6) and (7) should be introduced into the the same resources were analyzed in each model, with the duration

410 T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413

Table 5

Data sets.

Data sets Operations Surgeons Anesthetists Nurses Renewable resources Non-renewable resources Operating rooms Recovery beds

D1 8 4 4 8 5 5 4 8

D2 15 7 4 8 5 5 4 8

D3 17 9 4 8 5 5 4 8

Table 6

Comparison of solutions obtained through MP-MOD.

MP-MOD

Data set Aﬃnity threshold Number of constraints Number of variables Number of solutions Makespan Time (opt.)

6 17061 6251 4 14 26.22

≥7 Infeasible

6 23350 10662 2 24 30.59

≥7 Infeasible

6 26620 12032 1 24 32.74

≥7 Infeasible

Table 7

Comparison of solutions obtained through CP-MOD.

CP-MOD

Data set Aﬃnity threshold Number of constraints Number of variables Number of solutions Makespan Time (best) End time

6 28985 616 1 14 2.52 94.3

≥7 Infeasible

6 45591 928 1 23 1.51 115.87

≥7 Infeasible

6 49263 1029 1 23 2.18 133.98

≥7 Infeasible

of the time slots set to 30 minutes (the greatest common factor of matrix inside a data set, the numbers of constraints and variables do

operation durations). Besides the performance comparison between not change along with the threshold value for a given data set, but in-

two models, their robustness is also evaluated using three datasets crease from a small data set to a larger one. In D1, eight surgical cases

of various sizes (from D1 to D3 in Table 5), with all constraints taken need to be scheduled; if the threshold value is set to 5 or 6, the objec-

into account. For example, the dataset 3 for this day consists of 17 tive function leads to an optimal solution to 14 time-slots within less

operations, 9 surgeons, 8 nurses, 4 anesthetists, 5 renewable material than 27 seconds. Using D2 and D3, the optimal solution found - also

resources and 5 non-renewable resources. The differences between within a reasonably short time - is that all surgical cases can be ﬁn-

datasets consist in the numbers of operations and of surgeons. ished before the end of 24th time-slot. When the threshold value goes

As mentioned earlier in Section 2.1, the integer aﬃnity matrix is beyond 6, no any feasible solution can be found, because no surgi-

transformed into a binary matrix by using a threshold value. In the cal teams can be formed. The column ‘Number of solutions’ indicates

presented results the threshold value is set to 5, the median value. It that the number of feasible solutions found before the solver termi-

will then be increased successively in a sequence of testing scenarios nates. There are a few solutions which can satisfy all the constraints.

as shown in Table 6. This phenomenon, as mentioned at the beginning of the paper, cor-

responds to the main characteristic of highly constrained problems.

5.2. Computational results with the makespan objective Table 7 shows the results generated by the CP-MOD. With re-

gard to constraints, their number is much larger in CP-MOD than in

The objective function in both models is deﬁned by a simple for- MP-MOD, because the CP engine needs to generate more domain in-

mulation that minimizes the makespan, that is, the maximum job formation about the variables from the compact formulation of the

completion time, as presented by the functions (1a) and (42). Tables problem, in order to perform a ﬁltering algorithm. In consequence,

6 and 7 compare the computational results of the two models. much more memory is required. However, fewer variables are em-

Table 6 gives the results obtained from experiments using the MP- ployed since an operation is represented by only one interval variable,

MOD. All the three data sets have been introduced into the model suc- instead of a sequence of binary variables. An important phenomenon

cessively, and for each of these data sets, different threshold values should be noted; the numbers of constraints and variables decrease

have been applied. Since the threshold value only affects the aﬃnity when the threshold value increases from 5 to 6, as opposed to what

T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413 411

Table 8

Comparison of solutions obtained through MP-MOD.

MP-MOD

Data set Aﬃnity threshold Number of constraints Number of variables Number of solutions Makespan Time (opt.)

6 17052 6241 3 14 1.64

≥7 Infeasible

6 23334 10645 1 23 1.96

≥7 Infeasible

6 26602 12013 1 23 3.95

≥7 Infeasible

Table 9

Comparison of solutions obtained through CP-MOD.

CP-MOD

Data set Aﬃnity threshold Number of constraints Number of variables Number of solutions Makespan Time (best) End time

6 28985 616 2 14 1.9 240.94

≥7 Infeasible

6 45591 928 3 23 19.14 314.66

≥7 Infeasible

6 49263 1029 12 23 133.78 407.98

≥7 Infeasible

we have indicated in Table 6. The problem size is then reduced. As And in the CP-MOD

a result, the solver can ﬁnd a feasible solution much more rapidly.

Minimize w1 endO f (o) + w2 endO f (o)

In other words, the CP-MOD is highly sensitive to restrictions, even

o∈Ob o∈Om

when they are conﬁgured inside the input data. As for the solutions’

quality, only one solution has been identiﬁed in each scenario, but + w3 endO f (o) (51)

this ﬁrst and best solution was found slightly quicker than the cor- o∈Oe

responding computing time of the MP-MOD. In the cases where the where w1 , w2 , and w3 are non-negative weights and w1 >>w2 >>w3 .

threshold value is set to 6 in D2 and D3, the CP-MOD gives a bet- Tables 8 and 9 compare the computational results after imple-

ter solution than the MP-MOD in less than 3 seconds. The column menting this new objective function.

‘End time’ indicates the time spent before the CP-MOD reaches the Table 8 presents better results compared with those in Table 6.

fail limits1 . CP-MOD is obviously ineﬃcient in identifying optimal so- There is indeed a very small difference in terms of problem size after

lutions, due to long computing time. But it does not seem necessary changing the objective function, while optimal solutions are found

to seek the optimum solution for a highly constrained and frequently ten times faster than before. However, it should be noted that this

encountered problem, like the daily scheduling problem. weighted sum objective function remains a speciﬁc function specially

designed for our daily surgical scheduling problem. In contrast, our

initial objective function (minimizing the makespan) is a more gen-

5.3. Computational results with a weighted sum objective function eral function ﬁtting most scheduling problems.

Table 9 compares the results obtained from the CP-MOD after

The makespan objective function used initially in the two models changing the objective function to a weighted sum. With regard to the

is a logical function rather than a mathematical one. Now that the CP- problem size, none of the numbers of constraints and variables has

MOD with the makespan objective seems to be better than the MP- been changed, compared to Table 7. Though the same best makespan

MOD, it becomes necessary to estimate whether the CP-MOD retains can always be found in each experiment, the amount of time spent

an advantage under a pure mathematical objective function. A second has increased. Especially, the ‘End time’ becomes very long. The CP

objective function is then designed as follows. solver takes much more time to examine the feasibility of one poten-

In the MP-MOD tial solution. In addition, when D3 is used and the threshold value

is set to 6, the CP-MOD returned 12 feasible solutions, among which

Minimize w1 C2,o + w2 C2,o + w3 C2,o (50) 10 refer to the same makespan (i.e. 23). That means, a lot of alterna-

o∈Ob o∈Om o∈Oe tives have been found which satisfy all the constraints including all

the precedence constraints. Only the order of several surgical oper-

ations is different between two alternatives. In real life, any of these

1

Considering extremely long computing time before ﬁnding the optimal solution

alternatives conforms to what we expect in an operating theater; nev-

with CP optimizer, we set the fail limit to 200,000 in the CP-MOD as a stopping rule. ertheless, having more alternatives is conducive to the management

That means 200,000 failures can occur before terminating the search. of an operating theater facing unexpected events.

412 T. Wang et al. / European Journal of Operational Research 247 (2015) 401–413

6. Conclusions and perspectives Bulgarini, N., Di Lorenzo, D., Lori, A., Matarrese, D., & Schoen, F. (2014). Operating room

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16.

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Belgium: GISEH’04 9-11 September.

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Krzysztof, R. A. (2003). Principles of constraint programming. Cambridge: Cambridge

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in ﬁnding optimal solutions, but it is more eﬃcient in generating fea- Kurmann, A., Tschan, F., Semmer, N. K., Seelandt, J., Candinas, D., & Beldi, G. (2010).

Human factors in the operating room – The surgeon’s view. Trends in Anaesthesia

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